Assessment for self harm/suicide in persons with priority mental, neurological and substance use disorders

Question 1: Is there an added value to having health workers ask persons diagnosed with depression, bipolar disorder, schizophrenia, epilepsy, alcohol use disorders, illicit drug use disorders, dementia, children diagnosed with mental disorders, or persons reporting current interpersonal conflict, current intimate partner violence or physical or sexual abuse, or current loss, chronic physical illness or chronic pain and who do not report thoughts, plans or acts of self-harm, about thoughts or plans of self-harm in the last month or acts of self-harm in the last year versus not asking them?

Management of self harm and suicide

Population: adults and children with mental, neurological and substance use conditions as mentioned above, who do not report thoughts, plans or acts of self-harm

Interventions: health workers asking them about thoughts or plans of self-harm in the last month or acts of self-harm in the last year

Comparison: care as usual

Outcomes:

lifetime rates of suicide attempts

number of suicide attempts

observed number of suicides

frequency of suicide as a cause of death

frequency of these conditions in people who died by suicide

frequency of people with suicide ideation

frequency of people who presented to hospital following a self-harm/suicide attempt with these conditions.

Recommendation(s)

Non-specialist health care providers should ask individuals over 10 years of age suffering from depression, bipolar disorder, schizophrenia, epilepsy, alcohol use disorders, illicit drug use disorders, dementia, children diagnosed with mental disorders, or individuals, who present with chronic pain or acute emotional distress associated with current interpersonal conflict, recent loss or other severe life event, about thoughts or plans of self-harm in the last month or acts of self-harm in the last year at initial assessment and periodically as required.
Strength of recommendation: STRONG